睫状体视网膜动脉闭塞伴进行性视神经头缺血：病例报告

摘要(中文译文)

睫状视网膜动脉阻塞是一种少见的视网膜血管急症，可导致急性单眼视力丧失，尤其当黄斑区受累时。非动脉炎性前部缺血性视神经病变是另一种累及视神经乳头的缺血性疾病，通常与视盘水肿和无痛性突发视力损害相关。尽管这两种疾病均涉及与后睫状循环相关的血管区域，但睫状视网膜动脉阻塞与视神经乳头缺血之间的时间关系和病理生理关系仍尚未完全明确。本病例报告一名62岁女性，2型糖尿病控制不佳，因右眼急性无痛性视力丧失就诊。初诊眼底检查显示视盘苍白和水肿，灰白色视网膜水肿自视盘延伸至黄斑区，黄斑受累，动脉变细。多模式眼科评估，包括眼底照相、Humphrey视野检查、光学相干断层扫描、视觉诱发电位检查和眼底荧光素血管造影，支持睫状视网膜动脉阻塞合并视神经乳头缺血性受累且呈进行性，临床符合疑似非动脉炎性前部缺血性视神经病变。由于已超过溶栓时间窗，遂启动视网膜动脉阻塞的保守治疗。在视盘水肿进展及血管造影证实视神经乳头渗漏后，考虑到全身使用糖皮质激素的相关风险，给予球旁注射曲安奈德。随访期间观察到视盘水肿部分消退和视力有限改善；然而，单病例设计及同时进行的多种治疗使无法就治疗疗效得出任何结论。本病例强调，睫状视网膜动脉阻塞中的视盘改变应动态监测，并采用多模式影像学进行解读，而不应假定其代表固定的序贯性诊断模式。

Abstract

Cilioretinal artery occlusion is an uncommon retinal vascular emergency that can cause acute monocular visual loss, particularly when the macular region is involved. Non-arteritic anterior ischemic optic neuropathy is another ischemic disorder involving the optic nerve head and is usually associated with optic disc edema and sudden painless visual impairment. Although both conditions involve vascular territories related to the posterior ciliary circulation, the temporal and pathophysiological relationship between cilioretinal artery occlusion and optic nerve head ischemia remains incompletely defined. This case describes a 62-year-old woman with poorly controlled type 2 diabetes mellitus who presented with acute painless visual loss in the right eye. Initial fundus examination showed optic disc pallor and edema, grayish-white retinal edema extending from the optic disc to the macular region, macular involvement, and arterial attenuation. Multimodal ophthalmic evaluation, including fundus photography, Humphrey visual field testing, optical coherence tomography, visual evoked potential testing, and fundus fluorescein angiography, supported a diagnosis of cilioretinal artery occlusion with concurrent and progressive optic nerve head ischemic involvement, clinically consistent with suspected non-arteritic anterior ischemic optic neuropathy. Because the time window for thrombolysis had passed, conservative management for retinal arterial occlusion was initiated. After progression of optic disc edema and angiographic evidence of optic nerve head leakage, parabulbar triamcinolone was administered after consideration of systemic steroid-related risks. Partial reduction of optic disc edema and limited visual improvement were observed during follow-up; however, the single-case design and concurrent treatments preclude any conclusion regarding treatment efficacy. This case emphasizes that optic disc changes in cilioretinal artery occlusion should be monitored dynamically and interpreted using multimodal imaging rather than assumed to represent a fixed sequential diagnostic pattern.

如何引用

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